What India must do to solve its mental health crisis

There is a desperate need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start.

“We just don’t know what she went through,” a friend told me when we lost a close friend – who struggled with poor mental health for years – to suicide. This remains one of India’s biggest challenges in addressing mental illness: a general lack of mental health literacy. Mental illnesses – anxiety, depression, Post-traumatic Stress Disorder, Obsessive Compulsive Disorder, bipolar disorder, schizophrenia among many others – are neglected in India.

Today, April 7, marks World Health Day, on which the World Health Organization (WHO) in 2019 is focusing on universal health coverage. India has taken a step in the right direction, specifically towards mental health insurance and through the Mental Health Act, 2017. But why does India rank poorly in treating mental illnesses?

In April 2018, a study titled How India Perceives Mental Health across eight cities with 3,556 respondents provides an insight. It revealed that although 87% of the respondents were aware of mental illnesses, 71% used terms associated with stigma - “stupid”, “mad”, “crazy” and even “retard” – to describe mental illnesses. Recently, politician Akhilesh Yadav was criticised for calling the BJP “schizophrenic”.

In a comprehensive piece titled “Generation Stress” in Foreign Affairs, Sylvia Mathews Burwell looked at three factors behind the mental health crisis on American college campuses. These factors intersect in a country with a complex socio-cultural setup like ours. They are: safety, economics and technology.

Examining the factors:

Safety: In India there are two cohorts which greatly lack safety: gender and certain castes. While India is making strides towards inclusion, it is time to push the boundaries. It should start with the recognition that depression is more common in women than in men (World Mental Health report, WHO). But gender isn’t just about women. India celebrated the historic Supreme Court verdict decriminalising homosexuality. But questions of equal opportunity and social inclusion remained. The civil rights of the LGBTQ+ community continue to be limited. Caste further exacerbates the problem. “The pervasive socioeconomic exclusion faced by the LGBTIQA+ community in intersection with caste, class and gender sets up a structural baseline of insecurity. Social exclusion, shaming and abuse can constitute serious blows to one’s mental health”, said Karthik Bittu Kondaiah, a trans-activist and scientist. Gender and caste determine access and opportunity, and therefore, one’s place in society. Lower castes face intergenerational trauma through social exclusion, oppression and negative stereotyping, leading to poor mental health and stigma.

Economics: In many low-to-middle income countries, there are many hurdles in the way of upward mobility. This is especially true for India, with a vast rural-urban divide, a growing unorganised sector and little to no dignity of labour. Writing for The Hindu in October 2018, Jacob Koshy and Bindu Shajan Perapaddan observe that the rural youth’s mental health is most neglected. Interestingly, since villages are more community-oriented than cities, the environment is more conducive to address such issues. However, India’s dismal ratio of one psychiatrist per every 100,000 persons (National Mental Health Survey, 2015-16) proves that even if there is access, options for professional intervention are severely limited and unaffordable. Dr Purnima Nagaraja, a therapist and psychiatrist, believes that people need to move away from an “anti-psychiatry” attitude and seek help. “But due to entrenched patriarchy, vulnerable groups, such as women and children, are often deemed to be overreacting or seeking attention. There is no support system for women since it involves time and money, causing them to believe that they’re a burden on the family.”

Technology: Over-dependence on technology has been shown to be harmful to the mind. A study by Amy L Gonzales (Cornell University) proves technology helps social diversification. It pushes disadvantaged communities to virtual conversations which they would otherwise prefer not to have. Technology can push people into categories of haves and have-nots, but can serve as a problem and a solution. Dr Rajneesh Choubisa, an assistant professor at BITS Pilani, who works on technology and wellbeing believes that “technical and digital literacy” can help spread awareness. “We can solve issues through carefully-crafted interventions to rationalise and control the problem.” For instance, since viral content registers and plays up in one’s psyche, positive content on mental health can trigger a change in attitudes.

India’s Mental Healthcare Act (2017) provides, protects, promotes and fulfils the rights of persons with mental illnesses. The Mariwala Health Initiative, Bridge the Care Gap wants to prioritise mental health in policymaking. “As political parties are currently working on their manifestos, this is the right time to intervene and make a difference in the lives of millions of people affected by psychosocial disabilities”, Harsh Mariwala, chairman of Marico says on their website. While this move is welcome, policy alone won’t work. There is a need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start. “The conversation is slowly beginning, both in rural and urban India. But once help-seeking behaviours change, that is, when people start to look at mental illnesses the way they would their physical health and destigmatise it by asking for help, we can move from conversation to treatment”, Dr Purnima adds.

As the first director-general of the WHO, Brock Chisholm declared in 1954, “Without mental health there can be no true physical health.” So, even though Mental Health awareness has its own day (October 10), it’s important to keep the two together.